The chilling dilemma of “the unbefriended elderly,” who don’t have family or close friends to make medical decisions on their behalf if they can’t speak for themselves, generated a bunch of ideas the last time we discussed it.

One reader, Elizabeth from Los Angeles, commented that as an only child who had no children, she wished she could hire someone to take on this daunting but crucial responsibility.

“I would much rather pay a professional, whom I get to know and who knows me, to make the decisions,” she wrote. “That way it is an objective decision-maker based on the priorities I have discussed with him/her before my incapacitation.”

Elizabeth, it turns out other people have been thinking the same way.

A few years back, Elena Berman, a retired administrator at the University of Arizona, was trying to put her own paperwork in order and wondering about her health care proxy. She’s single and has no children, and her only sibling lives halfway across the country.

“When I tried to think whom I might ask to fill this position, no relative came to mind,” she told me in an interview. Two friends agreed to be her decision-makers, but they are about her own age. “That’s great if I die in five years or so,” said Dr. Berman, who is 66. “But after that, it’s up for grabs.”

With people living longer and families having fewer children, she pointed out, “I see this as a growing population.”